It makes far more sense to look at the diseases and conditions to which we know medical science can make a real difference--cancer, diabetes, and hypertension, for example. The largest international study to date found that the five-year survival rate for all types of cancer among both men and women was higher in the U.S. than in Europe. There is a steeper increase in blood pressure with advancing age in Europe, and a 60 percent higher prevalence of hypertension. The aggressive treatment offered to U.S. cardiac patients apparently improves survival and functioning relative to that of Canadian patients. Fewer health- and disability-related problems occur among U.S. spinal-cord-injury patients than among Canadian and British patients.

Do Patients in Other Countries Have Better Access to Care?

Britain has only one-fourth as many CT scanners per capita as the U.S., and one-third as many MRI scanners. The rate at which the British provide coronary-bypass surgery or angioplasty to heart patients is only one-fourth the U.S. rate, and hip replacements are only two-thirds the U.S. rate. The rate for treating kidney failure (dialysis or transplant) is five times higher in the U.S. for patients between the ages of 45 and 84, and nine times higher for patients 85 years or older.

Overall, nearly 1.8 million Britons are waiting for hospital or outpatient treatments at any given time. In 2002-2004, dialysis patients waited an average of 16 days for permanent blood-vessel access in the U.S., 20 days in Europe, and 62 days in Canada. In 2000, Norwegian patients waited an average of 133 days for hip replacement, 63 days for cataract surgery, 160 days for a knee replacement, and 46 days for bypass surgery after being approved for treatment. Short waits for cataract surgery produce better outcomes, prompt coronary-artery bypass reduces mortality, and rapid hip replacement reduces disability and death. Studies show that only 5 percent of Americans wait more than four months for surgery, compared with 23 percent of Australians, 26 percent of New Zealanders, 27 percent of Canadians, and 36 percent of Britons.

Congress is preparing to debate health care reform proposals this summer. However, legislation allowing the government to take over health care decisions for families could have dire consequences. A close examination of government-run health care in Canada and the United Kingdom shows sharp contrasts in the quality of medical services:

 Delay is denial of care. In the U.S., only 26 percent of sick adults waited more than four weeks to see a specialist. In Canada and the UK, more than twice as many citizens wait longer than a month to receive the care they need (60 percent and 58 percent, respectively). Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

 The sickest patients need intensive care. In Britain, government hospitals maintain nine intensive care unit beds per 100,000 people. In America, we have three times that number at 31 per 100,000. Source: High-Priced Pain: What to expect from a Single-Payer Health Care System, Heritage Foundation, 9/22/2006.

 U.S. Care for infants outpaces UK and Canada. In the U.S., we have over six neonatologists per 10,000 live births. In Canada, they have fewer than four and in Britain fewer than three. In the U.S., we have over three neonatal intensive care beds per 10,000 births, just 2.6 in Canada and less than one in Britain. Source: High-Priced Pain: What to expect from a Single-Payer Health Care System, Heritage Foundation, 9/22/2006.

 Long waits increase pain and morbidity. In the U.S., over 90 percent of seniors receive a hip replacement within six months. In Canada, less than half of patients are treated in the same time (43 percent) with many waiting over a year. In the UK, only 15 percent of patients are treated within six months. Source: Doing Your Own Health Care Thing: American Seniors vs. Canadian Citizens, Heritage Foundation, 7/1/2005.

 New technology finds cancer quicker. In America, doctors use 27 MRI machines per million people. In Canada and Britain, it is less than a fifth of that at approximately five MRI machines per million people. Source: Health Status, Health Care and Inequality: Canada vs. the U.S., National Bureau of Economic Research, September 2007.

 Americans take advantage of preventative care. Nearly 90 percent of American women age 40  69 have had a mammogram, while only 72 percent of Canadian women have had a screening. Likewise, 96 percent of American women age 20 - 69 have had a Pap smear, with 88 percent of Canadian women undergoing the test for cervical cancer. Source: Health Status, Health Care and Inequality: Canada vs. the U.S., National Bureau of Economic Research, September 2007.

 Cancer survival rates higher in the U.S. One study puts the five-year cancer survivability rate for American women at 63 percent, but only 56 percent for European women. For men, the difference is starker with 66 percent survivability for Americans and only 47 percent for Europeans. A separate comparison of U.S. and Canadian citizens shows similar results. American womens survival rate is 61 percent, compared to 58 percent in Canada. American mens survival rate is 57 percent, and 53 percent in Canada. Sources: Lancet Oncology, 2007, No. 8; Health Status, Health Care and Inequality: Canada vs. the U.S., National Bureau of Economic Research, September 2007.

Still a bit crazed from the cross country flight. These things affect me for longer than they do most people; but I did have a quick initial look at the health data from which the figures you quote seem to be derived.

You may be correct, but I believe there are some problems with the data that need to be addressed before I could actually agree with you. Not a large surprise there, I suppose, but the issues are real enough to my mind. The European data seems to be from actual statistics from folks whove come in with various forms of cancer and whove gotten treatment in the various government and private facilities in those places. The data is pretty solid and not what Id consider particularly worth being thrilled about in general. More machines and better access to meds are probably a good thing in many cases, though not necessarily in all cases. In one of the sources Denise quotes, for example, the folks brag about the higher ratio of Papp smears and Mammograms given as well as the high number of prostate cancer screenings that are given here in the states. This may not in fact be the best standard of care, and there is an ongoing medical debate about it. Charities who want high awareness focused on their illnesses are always in favor of these tests for good reasons. Not only does the money continue, but far more importantly, their particular illness may be dealt with more quickly. Its not all greed, after all.

While the number of cases that the European data is based on are much closer to 100% of the actual cases in the population, because the reporting is widespread, this is far from the case in the United States. SEER, the governmental statistics keeper here, only was able to present about 26% of the population for study in the year 2001, which was one of the two years the study in the Lancet Oncology Issue studied.

The NCI has recognized the need to better define the cancer burden in racial/ethnic minorities and medically underserved populations and supports research, applications and surveillance on the full diversity of the United States population. Since its inception in 1973, the the cancer registry system of the SEER Program has included large segments of diverse populations. Subsequent expansions increased the proportions of Hispanics, urban African Americans and Asian and Pacific Islanders in Southern California and the Greater Bay Area, rural African Americans in Georgia, northwestern populations in Seattle, Arizona Indians, and Alaska Natives residing in Alaska. An expansion in 2001 of four areas increased coverage of key populations, such as rural low-income whites, more geographically diverse American Indians, rural African-Americans and other Hispanic groups. This addition  the largest expansion to date  brings SEER coverage to 26% of the U.S. population.

26%, by the way, would usually be considered a stellar sample size, but in this case, this was a large change from the nature of the previous sample in terms of racial and ethnic diversity as well as geographic diversity, including a large apparent influx of rural populations. Tossing this population in the middle of a two year size sample is indeed something that could throw the data off significantly, and should have been compensated for in some fashion in the statistical model.

Since I dont have the money to buy access for a fuller version of the article, I dont know what was done here.

Nor do I know what the effect of having a large proportion of the US population not available to have their data reported upon due to poverty and other lack of access problems. Medical care for these folks, when it is available, tends to be available in a sporadic fashion.

A look at the actual data from The Lancet Study seems to me  by the way  somewhat different than the data that Denise presented, and should be looked at more closely before the conclusions Denise offers could be supported.

You should probably judge the conclusions for yourselves rather than accept the carefully cherry-picked and somewhat slanted data offered by the folks who have a political rather than a scientific point to make. Here are the findings direct from the synopsis of the article. The reference is below for your follow-up pleasure:

quote:

FindingsFor all cancers, age-adjusted 5-year period survival improved for patients diagnosed in 200002, especially for patients with colorectal, breast, prostate, and thyroid cancer, Hodgkin's disease, and non-Hodgkin lymphoma. The European mean age-adjusted 5-year survival calculated by the period method for 200002 was high for testicular cancer (97·3% [95% CI 96·498·2]), melanoma (86·1% [84·388·0]), thyroid cancer (83·2% [80·985·6]), Hodgkin's disease (81·4% [78·984·1]), female breast cancer (79·0% [78·180·0]), corpus uteri (78·0% [76·279·9]), and prostate cancer (77·5% [76·578·6]); and low for stomach cancer (24·9% [23·726·2]), chronic myeloid leukaemia (32·2% [29·035·7]), acute myeloid leukaemia (14·8% [13·416·4]), and lung cancer (10·9% [10·511·4]). Survival for patients diagnosed in 200002 was generally highest for those in northern European countries and lowest for those in eastern European countries, although, patients in eastern European had the highest improvement in survival for major cancer sites during 19912002 (colorectal cancer from 30·3% [28·332·5] to 44·7% [42·846·7]; breast cancer from 60% [57·263·0] to 73·9% [71·776·2]; for prostate cancer from 39·5% [35·044·6] to 68·0% [64·272·1]). For all solid tumours, with the exception of stomach, testicular, and soft-tissue cancers, survival for patients diagnosed in 200002 was higher in the US SEER registries than for the European mean. For haematological malignancies, data from US SEER registries and the European mean were comparable in 200002, except for non-Hodgkin lymphoma.

carefully cherry-picked and somewhat slanted data offered by the folks who have a political rather than a scientific point to make.

I saw nothing to indicate that they were politically slanted, unless figures contradicting democratic claims makes them automatically political to you, Bob. I considered them to be pretty fair links and reports.

WASHINGTON (AP)  House and Senate Democrats intend to bypass the traditional format when they negotiate a final compromise on health care legislation.

The move will exclude Republicans as well as reduce their ability to delay or force politically troubling votes in both houses.

The unofficial timetable calls for final passage of the measure to remake the nation's health care system by the time President Barack Obama delivers his State of the Union Address, likely in early February.

Democratic aides said the final compromise talks would essentially be a three-way negotiation involving top Democrats in the House and Senate and the White House. That structure gives unusual latitude to Senate Majority Leader Harry Reid, D-Nev., and Speaker Nancy Pelosi, D-Calif.

For the next democrat that tells me that the problem is the Republicans acting in a partisan manner......read my lips. This administration takes despicable to a new level and shows just how much of a liar Obama really is.

carefully cherry-picked and somewhat slanted data offered by the folks who have a political rather than a scientific point to make.

I saw nothing to indicate that they were politically slanted, unless figures contradicting democratic claims makes them automatically political to you, Bob. I considered them to be pretty fair links and reports.

Dear Mike,

Denise printed the data she got. I do not believe she would misprint data. Therefore the data is likely accurate. If it is not, you need to discuss that with Denise. I expect there will be nothing to discuss.

The data that The Lancet thought was the important data was the data reported in their summary.

If you have the money, of course, to get the full report, please do so. It's about 32 or 33 dollars, and I'd love to have a look.

The data the Lancet Oncology reported is different than the data that the sources quoted by Denise reported. That data was partial and unprocessed data from earlier in the report that did not show the amount of progress made in Eastern Europe or in Great Britain, that did not address the change in the data between 2001 and 2002 on the American reports either as to the populations or the areas from which the populations were gathered.

The Study that The Lancet Oncology did was not designed to report these data separately, but only as part of a larger sample. The statistical work that would have needed to be done to make the kinds of judgements that the publications that Denise quoted did in fact make do not show up in any of her material. Nor did it show up in mine. The material in The Lancet Oncology article would probably not have required these operations, such as  possibly  some form of end point analysis for the US data to either carry forward data from 2000 or in some other fashion to account for the change in data gathering and demographics in 2001.

Failure to do these things would have skewed the meaning of the data, and skewed it heavily and predictably. Failure to present the actual data at all, and presenting only raw and prejudicial data is, therefore, fairly clear and predictable cherry-picking.

I am your basic statistical amateur, however; and there are others out there who could make me look foolish. I would cheerfully accept a more experienced hand to explain where and how my thinking here has gone astray in large or small ways. If I don't risk looking foolish every now and again, I risk learning nothing new.

I think all science studies are based on averages, averages of something. Results would be dependent on what the criteria to be averaged is determined to be. I noticed with the Lancet, it said that it was 'age- adjusted'. I wonder what that means? Is that just referring to the five year period or the age of those studied?

Denise, you're starting to think about the data yourself. I suspect it had to do with the ages of those studied, which are often grouped in five-year segments (20-25, 25-30, 30-35 and so on, up and down) as a way of offering smaller chunks of data to look at all at once. That's my first take on it, at least. But what's your thought and what's your thinking as you look at the actual material more closely? I'm curious to know?